Active Compounds:S-adenosylmethionine is derived from
two chemicals: methionine, a sulfur-containing amino acid; and adenosine
triphosphate (ATP), the body's main energy molecule.

History:

SAMe
was discovered in Italy in 1952. It was first investigated as a treatment
for depression. It was accidentally noted to improve arthritis
symptoms—a kind of positive "side effect." SAMe is presently
classed with glucosamine and chondroitin as a potential "chondroprotective"
agent, one that can go beyond treating symptoms to actually slowing the
progression of arthritis. This has not yet been proven.

SAMe
is also sometimes used by Italian physicians in the first weeks of
conventional treatment for depression, because it is thought to act more
quickly than certain antidepressant drugs.

Remedies
For:

Principal Uses

· Osteoarthritis, Depression

Other Uses

· Liver Disease, Fibromyalgia

There
is growing evidence suggesting that SAMe is an effective treatment for
osteoarthritis. However, the supplements glucosamine and chondroitin are
much less expensive and just as well documented.

Several
small studies also suggest that SAMe can be helpful for depression.

This
supplement may be helpful for certain liver conditions such as the
jaundice of pregnancy and Gilbert's syndrome.

SAMe
may also help fibromyalgia.

New
evidence suggests that SAMe might help medications for Parkinson's disease
work better and with fewer side effects.

Scientific
Evidence of Effectiveness:

Osteoarthritis

Several
good scientific evidence supports the use of SAMe to treat osteoarthritis.
Double-blind studies involving a total of more than a thousand
participants suggest that SAMe is about as effective as standard
anti-inflammatory drugs.

A
double-blind placebo-controlled Italian study tracked 732 people taking
SAMe, naproxen (a standard anti-inflammatory drug), or placebo. After 4
weeks, participants taking SAMe or naproxen showed about the same level of
benefit as compared with those in the placebo group.

However,
it should be noted that the dosage of naproxen used in this study was
definitely on the low side, only 750 mg daily. This is about half the
amount most people would use for arthritis. If a normal dosage of naproxen
had been used, the therapeutic effect would probably have been greater,
and the drug might have proven more effective. Therefore, this study alone
does not prove that SAMe is as effective as conventional treatment when
taken in proper doses.

Another
double-blind study compared SAMe with a full dosage of the
anti-inflammatory drug, piroxicam. A total of 45 individuals were followed
for 84 days. The two treatments proved equally effective. However, the
SAMe-treated individuals maintained their improvement long after the
treatment was stopped, whereas those on piroxicam quickly started to hurt
again.

Other
studies showed that oral SAMe has equivalent benefits to various doses of
indomethacin, ibuprofen, and naproxen.

Depression

In the human body, SAM-e
works as a methyl donor, which affects more than 30 different chemical
reactions, including certain mood-enhancing brain chemicals like seratonin.The exact mechanism in which SAMe works is not yet know. There are
many possible theories on how this may be working. A 1999 article in
Newsweek stated, "Whatever the mechanism, there is little question
that SAMe can help fight depression."

SAMe's antidepressant
activity was first reported in 1976. Since then, several small
double-blind studies involving a total of about 175 individuals have found
oral SAMe to be an effective treatment for depression. Some of these
studies compared SAMe with placebo, while others used a control group
given another antidepressant drug.

In the last two decades,
40 clinical studies have been published with about 1400 patients.Although the number of patients is small, the results have beenconsistent.In 1994, a
psychiatrist in Rome compiled results from a dozen controlled trials and
concluded that SAM-e's effectiveness in treating depression "is
superior [to] that of placebo and comparable to that of standard...
antidepressants."

Some
research suggests that SAM-e may work faster than conventional
antidepressants, which often take several weeks to become effective.Researchers from the University of California, Irvine studied
eighteen patients hospitalized for depression in 1988. In this study,
intravenous SAM-e was compared to oral imipramine (Tofranil), a commonly
prescribed antidepressant.By
the end of the second week, 66% of the patients on SAM-e had improved by
at least 50%, while improvement was reported by only 22% of the imipramine
group.

In another small study at
UCI, severely depressed patients were given either SAM-e or desipramine (a
pharmaceutical antidepressant) for four-weeks.The SAM-e recipients showed a slightly higher response rate (62%)
compared to those on desipramine (50%).

Studies conducted thus
far seem to indicate that SAM-e may be as effective as traditional
antidepressants. However, research has revealed fewer side effects,
particularly as compared to the older drugs (tricyclics and MAO
inhibitors) commonly used before the availability of SSRIs like Prozac and
Zoloft.Reported side effects
of SAM-e have included mild stomach upset and headache, although
frequently these symptoms go away after a couple of weeks.

Caution:
Those with bipolar disorder (commonly called manic depression) should
avoid SAM-e because it can induce mania in people with the disorder.

Fibromyalgia

Few studies have been
conducted specifically with Fibromyalgia patients. One study of 47
Fibromyalgia patients demonstrated a significant reduction in tender
points.In this study,
patients were treated with daily intramuscular injections of 200mg of
SAM-e, in addition to taking 400mg orally.

Description:

Dosage:

A
typical full dosage of SAMe is 400 mg taken 3 to 4 times per day. Take it
for a few weeks and then try reducing the dosage. As little as 200 mg
twice daily may be sufficient to keep you feeling better once the full
dosage has "broken through" the symptoms.

Some people develop mild
stomach distress if they start full dosages of SAMe at once. To get around
this, start low and work up to the full dosage gradually.

Safety:

SAMe
appears to be quite safe, based on the results from both human and animal
studies. The most common side effect is mild digestive distress.

Like
other substances with antidepressant activity, SAMe might trigger a manic
episode in those with bipolar disease (manic-depressive illness).

Safety
in young children, pregnant or nursing women, or those with severe liver
or kidney disease has not been established.

There may be risks involved
in combining SAMe with standard antidepressants. Consult your doctor
before combining SAMe with any antidepressant medication.

Drug
Interactions

If
you are taking:

Standard
antidepressants: Do not take SAMe except on a physician's advice.

Medications
for manic-depressive disease: Do not take SAMe except on a physician's
advice.

Drugs
that are "excreted by conjugation": It is possible that use
of SAMe may require you to increase your medication dose. Ask your
pharmacist for advice.